Individual
KEAGHAN OTTENBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7128 FULTON ST E, ADA, MI 49301-8413
(616) 825-3530
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5151014380
MI
Other
Enumeration date
06/19/2020
Last updated
09/06/2023
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